╨╧рб▒с>■  ■                                                                                                                                                                                                                                                                                                                                                                                                                                                   ¤   ■   ■      !"#$%&'()*+,-./0123456789:;<=>?■   ■                                                                                                                                                                                                                                                               Root Entry        ▓Zд Ю╤д└O╣2║p╙їСи┼@АCONTENTS         zCompObj            V            ■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           last one first. №  REFERENCES List below three persons not related to you, whom you have known at least one year. №  If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements. AUTHORIZATION I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Company. I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing contained in this application , or conveyed during any interview , is intended to create an employment contract. I further understand and agree that if I hired my employment will be  at will and without fixed term, and may be terminated at any time , with or without cause and without prior notice , at the option of either myself or the Company . No promises regarding employment have been madeCHNKINK z°xTEXTTEXT╓'FDPPFDPP*FDPPFDPP,FDPCFDPC.FDPCFDPC0FDPCFDPC2STSHSTSH4STSHSTSH42SYIDSYIDP4SGP SGP l4INK INK p4BTEPPLC t4 BTECPLC Ф4(FONTFONT╝4hEOBJPLC $5HTCD PLC l5pTCD PLC ▄5LSTRSPLC (6PMCLDMCLDx6▓7ent eligibilHappy Beginnings APPLICATION FOR EMPLOYMENT We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. Consistent with the Americans with Disabilities Act, applicants may request accommodations needed to participate in the application process. PERSONAL INFORMATION Social Security Date Number Name Last First Middle Present Address Street City State Zip Permanent Address Street City State Zip Phone No. Referred by Are you 18 years of age or older? O Yes O No EMPLOYMENT DESIRED Date You Salary Position Can Start Desired If so, may we contact Are you employed now? O Yes O No your present employer? O Yes O No Ever applied to this company before? O Yes O No Where? When? EDUCATION Circle Last Did you Name and Location of School Year Completed Graduate Subject Studied Grammar School 1 2 3 4 O Yes O No High School 1 2 3 4 O Yes O No College 1 2 3 4 O Yes O No Trade School, Etc. 1 2 3 4 O Yes O No GENERAL Subjects of Special Study or Research Work Job Related Skills(CPR &First Aid Certified, Drivers License, etc.) FORMER EMPLOYERS List below your last four employers, starting with the to me, and I understand that no such promise or guarantee is binding upon Company unless made in writing.\ If I am offered employment I agree to a medical examination and drug test before starting work . If employed I also agree to submit to a medical examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and test, and I request that the examining doctor disclose to the Company the results of the examination, which results of the examination , which results shall remain confidential and segregated from my personal file. I understand that my employment or continued employment to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test , and if I am hired a condition of my employment will be abide by the company s Drug and Alcohol Policy. I understand that filling out this form does not indicate there is a person open and does not obligate the company to hire. If hired I agree to abide by all company work rules , policies and procedures. The Company retains the right to revise its procedures in whole or part , at any time. 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